<%@ page language="java" contentType="text/html; charset=utf-8"
    pageEncoding="utf-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
    <title>录入住院信息--理博软件2016</title>
    <meta charset="UTF-8">
    <link rel="stylesheet" type="text/css" href="statics/Css/bootstrap.css" />
    <link rel="stylesheet" type="text/css" href="statics/Css/bootstrap-responsive.css" />
    <link rel="stylesheet" type="text/css" href="statics/Css/style.css" />
    <script type="text/javascript" src="statics/Js/jquery.js"></script>
    <!-- <script type="text/javascript" src="statics/Js/jquery.sorted.js"></script> -->
    <script type="text/javascript" src="statics/Js/bootstrap.js"></script>
    <script type="text/javascript" src="statics/Js/ckform.js"></script>
    <script type="text/javascript" src="statics/Js/common.js"></script>
    <script type="text/javascript" src="statics/Js/ckeditor/ckeditor.js"></script>
 

    <style type="text/css">
        body {
            padding-bottom: 40px;
        }
        .sidebar-nav {
            padding: 9px 0;
        }

        @media (max-width: 980px) {
            /* Enable use of floated navbar text */
            .navbar-text.pull-right {
                float: none;
                padding-left: 5px;
                padding-right: 5px;
            }
        }


    </style>
    <script type="text/javascript">
    $(function () {       
		$('#backid').click(function(){
				window.location.href="hosindex.do";
		 });
    });
    </script>
</head>
<body>
<form action="sucaddzyuan.do" method="post" class="definewidth m20">
<table class="table table-bordered table-hover definewidth m10">
    <tr>
        <td width="10%" class="tableleft">病历号</td>
        <td><input type="text" name="hosrId" id="hosrId" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">姓名</td>
        <td><input type="text" name="hosrName" id="hosrName" value=""/>
        	<!-- <span name="hosrName" id="hosrName"></span> -->
        </td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">证件类型</td>
        <td>身份证</td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">证件号</td>
        <td><input type="text" name="hosrIdcar" id="hosrIdcar" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">社保号</td>
        <td><input type="text" name="hosrMedical" id="hosrMedical" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">联系电话</td>
        <td><input type="text" name="hosrPhone" id="hosrPhone" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">是否自费</td>
        <td>
        	<input type="radio" name="hosrSelfprice" id="hosrSelfprice" value="" checked="checked"/>
        	<span id="Selfprice"></span>
        </td> 
    </tr>
    <tr>
        <td width="10%" class="tableleft">性别</td>
        <td>
        	<input type="radio" name="hosrSex" id="hosrSex" value="" checked="checked"/>
        	<span id="Sex"></span>
        </td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">年龄</td>
        <td><input type="text" name="hosrAge" id="hosrAge" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">初复诊</td>
        <td>
        	<input type="radio" name="hosrLookdoctor" id="hosrLookdoctor" value="" checked/>
        	<span id="Lookdoctor"></span>
        </td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">所挂科室</td>
        <td>
        	<select name="pId">
        		<option id="pId" value=""></option>
        	</select>
    </tr>
    <tr>
        <td width="10%" class="tableleft">指定医生</td>
        <td>
        	<select name="dId">
        		<option id="dId" value=""></option>
        	</select>
        </td>
    </tr>
	<tr>
        <td width="10%" class="tableleft">备注</td>
        <td><input type="text" name="hosrRemark" id="hosrRemark" value=""></td>
	</tr>
    <tr>
        <td width="10%" class="tableleft">护理</td>
        <td>
        	<select name="cId" id="cId"></select>
        </td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">床位号</td>
        <td><select name="bId" id="bId"></select></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">缴费押金</td>
        <td><input type="text" name="zprice" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">病情</td>
        <td><textarea name="zRemark"></textarea></td>
    </tr>
    <tr>
        <td colspan="2">
			<center>
				<button type="submit" class="btn btn-primary" type="button">保存</button> &nbsp;&nbsp;
				<button type="button" class="btn btn-success" name="backid" id="backid">返回列表</button>
			</center>
		</td>
    </tr>
</table>
<script type="text/javascript" src="statics/Js/hosadd.js"></script>
</form>
</body>
</html>